HealthLink launches campaign to boost messaging quality

Electronic messaging provider HealthLink has launched a campaign to encourage electronic medical record (EMR) and practice management software companies to improve the quality of electronic messaging.

HealthLink is setting up a capability register to track which vendors are working towards conformance with HL7 standards and to ensure that their systems are interoperable.

HealthLink's manager of vendor integration, Kyle Macdonald, said that to be truly useful, electronic messaging must be at least as reliable as paper-based information exchange or preferably more so.

“An increasing reliance on electronic messaging to replace paper-based processes has meant that it is becoming more urgent than ever to ensure that every electronic message is received by the intended recipient in exactly the manner and format intended,” Mr Macdonald said.

“Over the past few months a small number of incidents have come to light which can best be described as 'patient misadventure near-misses'. Specialists sending information to their referring general practices have found that lack of standards conformance among some of the EMR systems is reducing the reliability of the process. In the worst cases, messages are failing to be imported or the recipient systems are failing to notify the senders that this has happened.”

He said these examples showed the importance of ensuring consistent implementation of messaging standards, in particular the correct and reliable use of HL7 message acknowledgements.

“HL7 message acknowledgements are automated response messages that tell the sending system that its outgoing message has been received by the recipient’s system and correctly inserted into its database,” he said. “Each of these problems can be traced to one or more deficiencies in the way in which one or more EMR vendors has implemented electronic messaging capabilities within their products.”

He said a number of EMR system vendors had made significant strides in implementing message acknowledgements and message tracking capabilities within their systems but some practice systems have not made sufficient progress and a number of new systems have arrived on the market.

“In order to encourage continued progress in this important area, HealthLink is commencing a new marketing and education campaign to highlight the progress made and to draw attention to any remaining deficiencies,” he said.

“The emphasis of the campaign will be to ensure that practices are given all the help they need to understand where any potential problems and risks lie with their clinical messaging.”

HealthLink is contacting around 50 practice management software companies to ascertain the exact status of their systems, with the results to be published in Pulse+IT later this year.

The campaign follows a similar one in 2009, when HealthLink contributed to an article in Pulse+IT's November issue highlighting the poor adherence to HL7 standards within the Australian health sector.

HealthLink CEO Tom Bowden said the issue was extremely important considering that approximately 12,000 healthcare organisations in Australia and New Zealand exchange more than 100 million items of clinical information via their electronic medical record systems every year.

“If even one of those electronic messages fails to import, is deficient, incorrect or incomplete, it could mean life or death for a patient,” Mr Bowden said. “So it is absolutely essential that as a healthcare IT community we take every possible step to ensure that electronic communication is working perfectly.

“We hope that the Australian health IT community will work closely with us, just as they did in 2009, to bring each system up to the required level to guarantee quality information exchange and therefore certainty for patients and their carers.”

Comments

Surely this is the task of the Australian Healthcare Messaging Laboratory Service, not one of the individual Health Message Service Provider (MSP) vendors? The EMR/PMS vendors would certainly appreciate not having to deal with at least 4 different MSP vendor interpretations of the HL7 v2x message 'standards' - not to mention those of numerous individual healthcare organisations.

Anyway, who really wants the mailman to read their letters and send them back because the contents don't match a customised grammer and spell-checker?

Hi Stan,The article is not strictly about content, as you say vendors should use someone like AHML to support their HL7 construction. HealthLink fully supports AHML.The initial question is which EMRs have actually implemented working HL7 application acknowledgements regardless of Messaging Service Provider (MSP).

Appreciate your point, but not every MSP vendor supports HL7 v2 application acknowledgements - so maybe that is something for you guys to sort out when discussing inter-vendor messaging standards. Fortunately, you don't have to deal with the workflow issues at the Healthcare Organisations who have no process to deal with acknowledgements - particularly of the negative ('patient not known here') type.

Still, one step at a time - no one said that eHealth Interoperability was easy!

Due to the inability of third party messaging software products to be compatible with each other and forcing our clients into having to install many different pieces of third party messaging software, Shexie has taken the decision to provide its customers with a full SMD and document exchange messaging service compliant with NEHTA standards. This will enable all Shexie customers to NOT REQUIRE any third party messaging software to communicate with other software systems or their messaging products that support and are compliant with NEHTA standard secure messaging and document exchange. These capabilities will be provided in our next version of Shexie (Platinum) due late 2012..

Hi Randal,Sounds like a good initiative, but I wonder what can be done as far as message content issues are concerned as I believe SMD only deals with transport? Is NEHTA assisting the market in this regard?

The other thing that's starting to become apparent is that interchange fees might be expected by existing messaging providers, even in the SMD paradigm:

What a load of nonsense. Surely the objective is to get all the EMR vendors (and others) to send and recieve Nehta compliant, ie HL7/CDA documents using Nehta compliant SMD messages. These are the national ehealth objectives are they not. Or should we see each of the messaging vendors (ie the mailmen) dictating the landscape and produce their own capability matrices - one for Argus, one for 2 Hippo, one for ReferralNet, one for Medical Objects, one for MD Exchange...the list goes on and on. Get with the program Healthlink - ie the Australian National ehealth program not your petty self interest! Can you interoperate with any SMD compliant messaging system yet? Can you interoperate with any SMD compliant EMR yet?

Hi John,If only it was nonsense. HealthLink along with Argus are "in the program" and have been from the early days. Both companies have invested heavily in time, resources and opportunity costs to go on this NEHTA journey. HealthLink is currently transporting live test SMD/CDA messages to EMR vendors who are in the program and HealthLink is working with the SMX partners to address the interoperability challenges.

You are however missing the point and ill informed if you think that SMD will be switched on and suddenly all existing messaging will work through this brand new standard. Having collectively built up decades of messaging experience the messaging companies are well aware of the challenges of real world implementation. HealthLink alone transports over 1million messages a week. It is my expectation that SMD/CDA will take many years to make any impact on these volumes, while everyone relearns the HL7 lessons in the SMD world.

In the meantime are you advocating everyone keeps on ignoring the current clinical risk? No-one else has stepped up to the plate and said this is not acceptable. For patient safety HL7 messages must be acknowledged appropriately. Should there be multiple capability tables? Ideally no, but we can only measure what we know and we make no excuses for knowing most about HealthLink. We recognise the contention that this brings, and this is why we are contacting EMR vendors to give them the opportunity to respond on their capabilities. The sector needs to treat this seriously, as the acknowledgement challenge is the same in the SMD/CDA world.

At the HIC conference, discussions with other messaging service providers, representatives of two universities and a number of people interested in messaging standards has revealed strong support for this initiative and we expect that future versions of the capability table will not just be from HealthLink but will have the endorsement of a wide range of influential parties. Grahame Grieve has added his voice to the discussion with a number of articles in the last few days (early August 2012) on the topic on his website www.healthintersections.com.au.

To be of legitimate and widespread value, the capability table needs to be viewed in the sectors interest. HealthLink wants to work collaboratively to ensure we all provide high quality electronic messaging and completely remove risk from the messaging equation. We’d certainly welcome any ideas that might help achieve this.